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FOR OFFICE USE: pppUCATtON FOR SANITATION PERMIT_. 4 --- Permit ....•- P r It O •••• , Y..... (CompleT ih Triplicates w.. .. y 7.6 ................ Date issue ........ This Permit Expires t Year From Date Issued ....... 10. Application is hereby made to the San Joaquin Loeol)4ealth District for a permit to construct and install the work herein described. This application is made in compliance with�tounty Ordinance No: 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... ........ / >. ..... ................CENSUS TRACT ................. ......_.. ....v��.�_�.�:_-:.��- ..... ._......... . ..... : : 1 .. .Phone .._..... Owner's Name ---��-'---�-� -•-----•--•--•.................. ............ .....f............................. ......... ........... C ...... .. ----•••-- ..City– ........... Address e ��.�.--�-------=••./..'........�...�.. ................................. ..License ................... Phone ........ Contractors Name _.. _. installation will serve: Residence Gg Apartment House 0 Commercial.tITraller Court 4 ..�'�..��.�•.,�,-,-:,,,,. ,�1 Motel ❑Other .. ` y Number of living units:__.�L Numbe of bedrooms,. Garbage Grinder -A.-•. Lot Size , �... X P-........ .:.__ va Water Supply: Public�System and name .:G> i ..•, � , ..4�rl� - - -•-y Loa'""'p,....�1 y Loa ❑ lP�.l�i ..Pr l to ❑ � f 4 O• Character of soil'to a depth of 3 feet: Sand{]Silt 1] Clay ❑ Peat.[ Sand m a Loom Hardpan`[) Adobe o FIII M6terlal ._.._....... If yes,type ............:.. i (Plot plan,showing size of-lot, location of system in relation to wells, 'buildings,- etc. must be placed on reverse aide.} f NEW INSTALLATION: (No septlp tank or seepage pit permitted If public sewer is available within 200 feet, PACKAGE TREATMENT ( ] SEPTIC TANK{ Size.... Liquid Depth . .._, Capacity .Material.....------- No. Compartments —-- f Foundation •••.-- Prop. fie ......... ....... t. ..... ................ ............. [ ] � .Well .............. --- ... Total Length ................i............. -_--. ._.. Length of each line_!............!_......,. Distance..:ta nearest: i� LEACHING LINE No. of Lines Type Filter g 'D' Box -.. Material ...............Depth .Filter Material rQ... .. .Llne . .......• ...... r .._.... Foundation P op . . Distance to nearest: Well ................. -•-•.........--•-----... SEEPAGE PIT [ ] t Depth .. ................ Diameter ._......--:_---. Number ............................ Rock Filled Yes ❑ a S N Water ""' ...Rock Size Water Table Depth ....:.........•_..,_.........--- ! Distance to nearest: Well _....Foundation .... Prop. line ..... ........... I ..................... REPAIR/ADDITION(Prev. Sanitation Permit# Date ..----------••-•=--=•-----...,__,_.} ; Septic Tank (Specify Requirements). --------•-••----------- ................... ...._......_,. X a � Disposal Field (Specify Requirementsi --- L� . s• � eu �� -. 1 {Draw existing and required addition on.reverse side) :. I hereby certify that I have prepared this application and that the work will be done in .accordance with San Joaquin County Ordinances, State Laws,lend Rules and Regulations of the San JoaquinX`Local Health:District. Home owner Or liven- sed agents signature certifiet.the following: 11 certify that in the performance of the work for,which this permit is issued, I'-shall not employ any.person In such ''Wanner as to become subject to Workman's Compensation laws of California." a Signed _-----------•-••---- Owner ' itle -. .......... ---•'- ------- -----_------------• - 7' % ... (if o r than owner) k 4'/- FOR DEPARYMENT USE ONLY ` ! ------!DATE .-;' = . APPLICATION ACCEPTED BY -.____. . BUILDING PERMIT ISSUED ------=-------- • ....... .......... ...........----------...------ :. ••........_.__:.._.._DATI ... - .............- ADDITIONAL COMMENTS ---- •--- ----- •--•---- -----------------------------------------••-------- = --------------- _ ---------------------_-- " --- --- ----- •--- •--------------...----------.............. Final Inspection by: .. °.. . , D -•-- . ate ' EH 13 24 .1-68 I I;ev;_5M SAN JOAQUIN LOCAL 1-IEALTH DISTRICT $ 7�i 3M